NPI | 1902394752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 69540) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-04-26 |
Last Update Date | 2025-03-10 |